Medications for BPH

Two approaches. Several options.

There are two main types of oral medications for BPH. The first type, Alpha-blockers, relax muscles in the prostate and bladder neck so that urine can flow more easily. The currently available alpha-blockers that are approved by the FDA for the treatment of BPH include: doxazosin, terazosin, alfuzosin, tamsulosin, and silodosin. The second type, 5-alpha-reductase inhibitors, or 5-ARIs, shrink the size of the prostate or stop it from growing bigger. The currently available 5-ARIs are finasteride and dutasteride. In some cases, the two types of medications are used together.

Alpha-blockers: Non-selective and selective

Alpha-blockers relieve BPH symptoms by relaxing the "smooth" muscles of the prostate and the neck of the bladder. In effect, alpha-blockers "unclamp" the hose (the urethra) allowing urine to flow more freely. They work quickly to relieve urinary symptoms, often within days to weeks, but do not change the size of the prostate.

"Non-selective" alpha-blockers also relax smooth muscle inside the blood vessels and may therefore lower blood pressure. In fact, some non-selective alpha-blockers were developed for lowering blood pressure.15
Selective alpha-blockers are designed to target the smooth muscle in the prostate and bladder neck and have less of an effect on smooth muscle in the blood vessels and other areas of the body.4

All alpha-blockers have been found to be equally effective in relieving the symptoms of BPH, but their side effects differ.4 The most common side effects of alpha-blockers are lightheadedness upon sitting up or standing up abruptly, dizziness, fainting, tiredness, nasal congestion, headache, and orgasm with reduced semen.4

5-Alpha-reductase inhibitors

The 5-ARIs work by interfering with the body’s production of a hormone called dihydrotestosterone or DHT. This can help stop the prostate from growing larger, and may even shrink the prostate in some men. The 5-ARIs are useful only for men with relatively large prostate glands.4 It may take 6 months or more before any improvements in symptoms can be felt.5 The most common side effects of 5-ARIs are mainly related to sexual function and include impotence, decreased libido (sexual desire), reduced semen with ejaculation, other ejaculation problems, and breast tenderness and/or enlargement.5

Combination therapy

Treatment with an alpha-blocker and a 5-ARI may be helpful for men with very large prostates and severe symptoms of BPH. In these patients, combination treatment may help keep BPH symptoms from getting worse and also reduce the need for surgery.4

Work with your doctor. Take an active role in your BPH treatment.

Whether you choose to watch and wait or begin medication for BPH symptoms, make sure your doctor is informed about any decisions that might affect your health.

Some herbal extracts such as saw palmetto and Pygeum africanum have been used to relieve the symptoms of BPH.6 However, there is no definitive clinical evidence that shows they are effective in the treatment of BPH, and the American Urological Association does not recommend their use.4 Speak to your doctor before you try alternative treatments such as herbal supplements.

Learn about treatment options for BPH

References

Fenter TC, Naslund MJ, Shah MB, et al. The cost of treating the 10 most prevalent diseases in men 50 years of age or older. Am J Manag Care. 2006;12(4 suppl):S90-S98
National Institute of Diabetes and Digestive and Kidney Diseases. Prostate enlargement: benign prostatic hyperplasia. NIH Publication No. 07-3012. June 2006.
Shvartzman P, Borkan JM, Stoliar L, et al. Second-hand prostatism: effects of prostatic symptoms on spouses’ quality of life, daily routines and family relationships. Family Pract. 2001;18:610-613.
American Urological Association. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol. 2003;170:530-547
Nickel JC. Comparison of clinical trials with finasteride and dutasteride. Rev Urol. 2004;6 Suppl 9:S31-9
Benign Prostatic Hyperplasia (BPH): A Patient’s Guide. Available at: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/patient-guides/bph_guide_2003.pdf. Accessed February 4, 2009.
Brawer MK. A multicenter study on the efficacy and safety of interstitial laser coagulation versus α-blockade in subjects with symptomatic benign prostatic hyperplasia: preliminary results. Rev Urol. 2005;7(suppl 9):S29-S33.
Medline Plus Medical Encyclopedia from NIH: Enlarged Prostate. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm. Accessed March 5, 2009.
Moriyama N, Nasu K, Takeuchi T, et al. Quantification and distribution of a1-adrenoceptor subtype mRNAs in human vas deferens: comparison with those of epididymal and pelvic portions. Br J Pharmacol. 1997;122:1009-1014.
Kuritzky L. A primary care physician’s perspective on benign prostatic hyperplasia. Rev Urol. 2003;5(suppl 5):S42-S48.
Wolters R, et al: Lower urinary tract symptoms: social influence is more important than symptoms in seeking medical care. BJU Int. 2002;90:655–661.
Rosen RC, Giuliano F, Cason CC. Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Eur Urol 2005;47:824–837.
Ponholzer A, Madersbacher S. Lower urinary tract symptoms and erectile dysfunction; Links for diagnosis, management and treatment. Int J Impot Res. 2007;19:544-550.
National Institute on Aging: Talking With Your Doctor. Available at: http://www.nia.nih.gov/HealthInformation/Publications/TalkingWithYourDoctor/. Accessed March 5, 2009.
de Mey C, Michel MC, McEwen J, Moreland T. A double-blind comparison of terazosin and tamsulosin on their differential effects on ambulatory blood pressure and nocturnal orthostatic stress testing. Eur Urol. 1998;33(5):481-8.
http://www.dictionary.com
Atlas of Human Anatomy, Frank H. Netter, MD, Ciba-Geigy Corporation, Summit, NJ, 1989.

Talking to your doctor

It may help you to fill out the American Urological Association BPH Symptom Score Questionnaire.

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